Diagnostic value of metagenomic next-generation sequencing in patients with osteoarticular infections: a prospective study

Abstract

Due to the limits of traditional microbiological methods and the complexity of osteoarthritis pathogens, only a few pathogens can be detected. We evaluated metagenomic next-generation sequencing (mNGS) for detecting pathogens in osteoarthritis infection samples. We prospectively included 150 patients with osteoarthritis infection who visited the Orthopedics Department of Shandong Provincial Public Health Center from 2023 to 2024, including 124 cases of primary osteoarthritis (POI) and 26 cases of invasive osteoarthritis (IOI). The most common pathogenic bacteria were Mycobacterium tuberculosis complex, Staphylococcus aureus, and Brucella melitensis. mNGS (75.33%) significantly improved the detection of pathogens in osteoarticular infections compared to conventional tests (CT) methods (36.67%). mNGS could detect a wider spectrum of pathogens compared to CT methods, especially for mixed and rare pathogens. The treatment strategies for patients with osteoarthritis infection could be adjusted based on the results obtained from mNGS testing. Furthermore, the abundance of M. tuberculosis complex, B. melitensis, and Staphylococcus epidermidis was significantly correlated with clinical indicators.IMPORTANCEIdentifying the microorganisms responsible for osteoarthritis infection could help with early diagnosis and treatment. In this study, we compared the pathogen detection rate of metagenomic next-generation sequencing (mNGS) and CT methods in patients with osteoarthritis infection and found that mNGS had a higher microbial detection rate and a broader spectrum of pathogens (especially for mixed pathogens). This study demonstrates that mNGS is an ideal tool for detecting pathogens in patients with osteoarticular infections.

Keywords: diagnosis; infection; invasion; osteoarticular infections; primary; tuberculosis.

Fig 1

The pathogenic bacteria spectrum of osteoarticular infection.

Fig 2

Comparison of the diagnostic performances of metagenomic next-generation sequencing (mNGS) and conventional tests (CT) methods. (A) Number of samples with total detected, partially detected, and no detected pathogens using mNGS and CT methods. (B) Number of samples in which pathogens were detected by only mNGS, both the mNGS and CT methods, and CT method only. *p < 0.05.

Fig 3

Comparison of pathogens detected using the mNGS and CT methods. (A) Comparison of the type of organisms detected using the mNGS and CT methods. (B) Pathogens identified using both the mNGS and CT methods, mNGS only, and CT method only. CT, conventional tests; mNGS, metagenomic next-generation sequencing.

Fig 4

The diagnostic performance of mNGS and CT methods in identifying suspected TB cases. CT conventional tests; mNGS, metagenomic next-generation sequencing.

Fig 5

Clinical impact of mNGS positive results. (A) Total osteoarticular infections group. (B) POI group. (C) IOI group. IOI, invasive osteoarthritis; POI, primary osteoarthritis.

Fig 6

The correlation between clinical indicators and microbial DNA abundance. The correlation between hemoglobin and M. tuberculosis complex (A), hemoglobin and B. melitensis (B), WBC and B. melitensis (C), WBC and S. epidermidis (D). WBC, white blood cells.